What is appendicitis?

The appendix is a finger-like structure at the junction of the small and large intestines. It serves no function in the human body. Inflammation of the appendix is called appendicitis. This is a common surgical emergency in children that requires prompt medical attention and hospitalisation. A delay in diagnosis and appropriate treatment is dangerous as the inflamed appendix may burst, spreading the infection in the entire abdominal cavity.

What are the causes?

The exact cause of appendicitis is not known. However, if faecal matter blocks the lumen of the appendix, the secretions keep collecting and may get infected causing appendicitis.
What are the symptoms?
Appendicitis is uncommon in children below the age of two. The usual symptoms of appendicitis are:

* Pain, that starts around the navel or belly button, but soon shifts to the right lower part of the tummy.
* Vomiting that usually follows the pain
* Fever
* Loss of appetite

The child is usually constipated, but occasionally the initial presentation may be with loose stools. The child becomes listless and lies quietly in bed. Movements may cause pain and he walks bent forwards with his hand to the tummy. He resents examination of his tummy, particularly the lower part.

When should the doctor be called?

Acute appendicitis must be suspected whenever a tummy ache lasts for more than 3-4 hours and is located in the right lower part; the child passes small quantity of mucousy stool frequently; has fever and vomiting; or, his tummy bloats. When suspected, the doctor must be immediately consulted. The child must not be given anything to eat or drink; or any pain relieving medicines till the doctor has examined him.
How is the diagnosis made?
The surgeon makes the diagnosis essentially on clinical evidence. There is no laboratory test that gives a foolproof diagnosis of acute appendicitis. Often blood and urine tests are done and an ultrasound scan of the abdomen asked for. These tests are done to support a diagnosis and not to make it. The most experienced surgeons may not be correct 100 percent of the time. Even if the tests are negative and the clinical suspicion is very high, it is safer to have a normal appendix removed than risk leaving an inflamed appendix inside the abdomen.

What is the treatment?

Much as one would like to avoid operations in children, the only treatment of acute appendicitis is appendicectomy, or removal of the appendix. This operation should be performed early to avoid the various complications of appendicitis. The operation is short and safe and performed under general anaesthesia. A small cut is made in the lower right part of the abdomen. The inflamed appendix is detached from the intestine and is removed. Any pus collection, if present, is mopped up. Children recover fairly quickly afterwards. The fever settles down in a day or two, they are allowed to eat within 2 days and are usually out of hospital within 3-4 days. They are back to school within a couple of weeks.

The appendix may be removed by the traditional open operation or by laparoscopy. The surgeon decides which is the more appropriate method in a particular case. Laparoscopy in children may not have the many advantages over the open operation as it does in adults.

What are the complications?

One of the dreaded complications of acute appendicitis in children is that it may burst, spreading infection in the entire abdominal cavity (peritonitis). This is a serious condition and the child becomes very sick. If a child, who is having severe pain of appendicitis, suddenly feels a relief from pain, this must raise an alarm. This may mean that the appendix has ruptured. Untreated appendicitis may also result in a localised collection of pus, called appendicular abscess.

Can it be prevented?

There is no known method of preventing appendicitis. However, children who eat a high fibre diet may have a lower chance of developing the disease.

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